INR range 2.0-4.0?

[sweetmarie]

Came across a fellow coumadin user and avr recipient in my town, the same type valve, the same hospital as me, etc. I was curious to find out what range they had set. The person told me 2.0-4.0. I didn`t say anything for fear to worry the person but is this range a bit wide:confused2:? Not sure if I remember reading about such a range on this board:eek2:. What are your thoughts?

 

[dick0236]

That would be a little unusual but would not be a real concern for me. My range has always been 2.5-3.5, but I am OK between 2-4 so long as I don't stay at the upper or lower readings for an extended length of time. It should make it easy to stay in range:wink2::biggrin2:.

 

[ALCapshaw2]

Most Doctors and anticoagulation managers prefer to specify a tighter range within that broader range of 2.0 to 4.0, taylored to the patient's valve (AVR vs MVR) and history (previous stroke, TIA, clotting disorder, etc.)

Generally speaking, the risk of clotting / stroke goes up rapidly below 2.0
and the risk of Bleeding goes up rapidly above 5.0
so yes, 2.0 to 4.0 is a 'mostly safe range' but is best narrowed a bit to optimize for the specific risk factors of the patient.

 

[Bina]

SM, I agree with the boys.....2.0--4.0 is the outer edge of our "safety net" and most of us aim for that sweet
INR of 3.0

 

[sweetmarie]

I guess what I was really wondering is how the dosage is controlled to keep within that broad range? I've been reading mostly about dosing charts in the 1.0 spans, not 2.0 spans. Is there a dosing chart to control 2.0-4.0?

 

[ALCapshaw2]

I guess what I was really wondering is how the dosage is controlled to keep within that broad range? I've been reading mostly about dosing charts in the 1.0 spans, not 2.0 spans. Is there a dosing chart to control 2.0-4.0?

I doubt that there is a Dosing Guide taylored to an INR of 2.0 to 4.0 since that is NOT a normally recommended range.

That said, I suppose the 'usual guideline' (No Change if you are in range) would apply.

 

[catwoman]

I doubt that there is a Dosing Guide taylored to an INR of 2.0 to 4.0 since that is NOT a normally recommended range.

That said, I suppose the 'usual guideline' (No Change if you are in range) would apply.

I haven't seen a dosing guide for 2.0-4.0.

I checked a warfarin app, which does specify a range of 2.5-3.5 or even 3.0-4.0 or a mechanical valver with systemic embolism despite therapeutic range. It says to add aspirin 50-100mg per day and/or increase INR target up one range (from 2.0-3.0 to 2.5-3.5 or 2.5-3.5 to 3.0-4.0). However, it only provides suggestions for adjusting targets of 2.0-3.0 or 2.5-3.5.
But since adjustments are recommended in percentages, you could figure it out by trial and error. Would not be difficult for some of us.

 

[sweetmarie]

I haven't seen a dosing guide for 2.0-4.0.

I checked a warfarin app, which does specify a range of 2.5-3.5 or even 3.0-4.0 or a mechanical valver with systemic embolism despite therapeutic range. It says to add aspirin 50-100mg per day and/or increase INR target up one range (from 2.0-3.0 to 2.5-3.5 or 2.5-3.5 to 3.0-4.0). However, it only provides suggestions for adjusting targets of 2.0-3.0 or 2.5-3.5.
But since adjustments are recommended in percentages, you could figure it out by trial and error. Would not be difficult for some of us.

Have to agree, it all boils down to percentages and the body's response to the dosing from what I'm learning.

 

[Protimenow]

I think the issue is partly that it's about ranges. Your INR one day may be a few tenths (or maybe more) higher or lower than it is the next day. Some of this variation may have something to do with the fact that many of us take a different dosage on some days than on others -- but it may also have something to do with diet, activities, phases of the moon or who knows what?

A lot of this DOES seem to be a bit of trial and error -- and concern that you don't make any drastic changes -- and the idea that your dosing should be on a weekly TOTAL, rather than daily tweaks.

Having your own meter makes it a lot easier to keep track of INR - especially if you're trying to get into range and stay in range - and have been making small adjustments to see that this happens.

 

[Herb M]

I keep my range between 3.0 and 4.0. I prefer to be close to the higher side. When I am above 3.5 my doctor tells me to hold the coumadin for a day and cut thr dose in half for two days. Of course I didn't do that.

 

[ALCapshaw2]

I keep my range between 3.0 and 4.0. I prefer to be close to the higher side. When I am above 3.5 my doctor tells me to hold the coumadin for a day and cut thr dose in half for two days. Of course I didn't do that.

GOOD GRIEF! When did your Doctor last attend an AntiCoagulation Continuing Education Class?

His reaction is WAY Out of Date and DANGEROUS.

Most of us on this forum would NEVER Hold a Dose for an INR under 5.0 (or 4.5 at the lowest).

 

[catwoman]

I keep my range between 3.0 and 4.0. I prefer to be close to the higher side. When I am above 3.5 my doctor tells me to hold the coumadin for a day and cut thr dose in half for two days. Of course I didn't do that.

If you have a smart phone, download the free WarfarinGuide app. Just search WARFARIN. It's the 2nd one that pops up on my phone, is by Justin Steinberg MD. Icon is a red square that looks kinda like a clock with II, VII, IX & X on the face (I presume the vitamin K factors that warfarin counteracts). Among the references is a paper by Jack Ansell, one of the best-known names in anticoagulation therapy management. The disclaimer is pretty sensible.

The app is pretty darned good, IMHO.

 

[sweetmarie]

Came across a fellow coumadin user and avr recipient in my town, the same type valve, the same hospital as me, etc. I was curious to find out what range they had set. The person told me 2.0-4.0. I didn`t say anything for fear to worry the person but is this range a bit wide:confused2:? Not sure if I remember reading about such a range on this board:eek2:. What are your thoughts?

Met with this person again today and told me that the range is not 2.0-4.0, it's 2.0-3.0. Sorry for the confusion.

 

[Protimenow]

If you have a smart phone, download the free WarfarinGuide app. Just search WARFARIN. It's the 2nd one that pops up on my phone, is by Justin Steinberg MD. Icon is a red square that looks kinda like a clock with II, VII, IX & X on the face (I presume the vitamin K factors that warfarin counteracts). Among the references is a paper by Jack Ansell, one of the best-known names in anticoagulation therapy management. The disclaimer is pretty sensible.

The app is pretty darned good, IMHO.

Marsha:

Which Smartphone is this app for? (I haven't tried to find this with my Blackberry yet).

 

[RobThatsMe]

I don't see a real issue with the 2.0 to 4.0 range.
Although, I mostly use 2.5 to 3.5.

Here's another way to look at this.
The mid point between 2.0 and 4.00 is 3.00
The mid point between 2.5 and 3.5 is also 3.00

So, if you target 3.00 your on the mark!

Rob

 

[catwoman]

Marsha:

Which Smartphone is this app for? (I haven't tried to find this with my Blackberry yet).

I have an iPhone. (Chucked my beloved dumbphone, a Nokia, after 5 years and got an iPhone last month.) If Blackberrys have apps, you might want to search for anything with WARFARIN.